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Review
. 2024 Feb 23:50:102376.
doi: 10.1016/j.jcot.2024.102376. eCollection 2024 Mar.

Risk factors for tibial infections following osteosynthesis - a systematic review and meta-analysis

Diana Niebuhr  1 , Thomas Mattson  2 , Niels Martin Jensen  3 , Bjarke Viberg  1   4   5 , Signe Steenstrup Jensen  1   6
Affiliations
Review

Risk factors for tibial infections following osteosynthesis - a systematic review and meta-analysis

Diana Niebuhr et al. J Clin Orthop Trauma. .

Abstract

Aim: This study aimed to quantitatively summarise risk factors associated with surgical site infection (SSI) following surgically managed tibial fractures.

Method: We searched the Embase/Medline, Cochrane Library, and Scopus databases for relevant studies in October 2023. We included original studies investigating risk factors for SSI following surgically managed traumatic tibial fractures that included ≥10 adult patients with SSIs. Meta-analysis was performed when >5 studies investigated the same risk factor. The risk of bias was assessed using the critical appraisal checklist from Joanna Briggs Institute for cohort studies.

Results: This study included 42 studies comprising 24,610 patients with surgically managed tibial fractures and 2,418 SSI cases. The following were identified as significant risk factors for SSI (p < 0.05): compartment syndrome (odds ratio [OR] = 3.8, 95% confidence interval [CI]: 2.4-6.0), blood transfusion (OR = 3.8, 95% CI: 2.1-6.6), open fracture (OR = 3.6, 95% CI: 2.5-5.1), Gustilo-Anderson classification >2 (OR = 3.1, 95% CI: 2.1-4.6), external fixation (OR = 2.9, 95% CI: 2.3-3.8), American Society of Anesthesiologists classification >2 (OR = 2.5, 95% CI: 1.5-4.1), polytrauma (OR = 2.4, 95% CI: 1.5-4.0), dual incision approach (OR = 2.1, 95% CI: 1.5-3.0), smoking (OR = 1.8, 95% CI: 1.5-2.1), male sex (OR = 1.6, 95% CI: 1.3-1.8), high energy trauma (OR = 1.5, 95% CI: 1.1-2.1), and prolonged surgery time (OR = 0.62, 0.43-0.82). Other factors, including diabetes, hypertension, and time to surgery, were not identified as risk factors for SSI. However, the included studies were generally of poor quality and at risk of bias.

Conclusions: The review provides a basis for preoperatively assessing a patient's risk of developing an SSI, which could be used to initiate adjusted antibiotic regimes and more frequent postoperative controls. Furthermore, it indicates the risk factors future research should include when adjusting for confounding factors.

Keywords: Fractures; Meta-analysis; Osteosynthesis; Risk factors; Surgical site infection.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flowchart.
Fig. 2
Fig. 2
Risk of Bias Assessment Green (✓) is ‘Yes’, yellow (?) is ‘Unclear’, red (✕) is ‘No’ and grey (0) is ‘Not applicable’.
Fig. 3
Fig. 3
Risk Factor Occurrences Blue bar depicts total number of risk factor occurrences and orange bar depicts number of significant results.
See this image and copyright information in PMC

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